KERN HEALTH SYSTEMS REQUEST FOR PROPOSAL SUBMISSION CHECKLIST

Transcription

1 KERN HEALTH SYSTEMS REQUEST FOR PROPOSAL SUBMISSION CHECKLIST Kern Health Systems (KHS) is a government agency dedicated to running a fair bidding program to foster high quality business relationships. In preparing an RFP response, please bear the following in mind: 1. There is a deadline for submitting questions to KHS about this RFP. 2. There is a deadline for submitting bids to KHS. 3. Every bid package must include: a. Answers to questions in Attachment A b. Answers to questions in Attachment B c. Answers to questions in Attachment C d. Signed copy Attachment D e. Signed copy of Attachment E f. Bidders PSA terms and conditions objections and explanations thereof as an additional Attachment F

2 KERN HEALTH SYSTEMS 9700 Stockdale Highway Bakersfield, CA Request for Proposal Professional Services Agreement To Core Software System 1/31/2014

3 TABLE OF CONTENTS A. INSTRUCTIONS AND CONDITIONS 1. Definitions 2. Preparation of Responses 3. Explanation to Bidders 4. Amendments 5. Submitting Proposals 6. Non-Collusion Affidavit 7. Bidders Response Information 8. Award of Contract 9. Evaluation Process 10. Company Evaluation 11. Late Bids 12. Cost of Preparation of Bids 13. Withdrawal of Bids 14. Payment 15. Miscellaneous 16. Timeline B. STATEMENT OF PURPOSE C. BACKGROUND INFORMATION ATTACHMENTS Attachment A: Scope of Services Attachment B: Schedule of Fees Attachment C: Company Evaluation Criteria Attachment D: Proposal Signature Verification Attachment E: Non-Collusion Affidavit Attachment F: Sample Professional Service Agreement (PSA)

4 A. INSTRUCTIONS AND CONDITIONS 1. Definitions a. As used herein, RFP means Request for Proposal. b. As used herein, KHS means Kern Health Systems. 2. Preparation of Responses (Instructions to Bidders) a. Before submitting a Proposal, each Bidder is expected to thoroughly examine the specifications in the Attachments, and all other related contractual documents included in this RFP, including subsequent amendments to the RFP. Failure to do so will be at the Bidder s risk, and will not bar the Bidder s obligation to perform if a contract is awarded pursuant to this RFP. b. Each Bidder shall submit, as part of their Proposal, completed copies of Attachments D, Proposal Signature Verification, and E Non-Collusion Affidavit. c. Each Bidder shall complete Attachments A, B, and C according to the instructions on each of the attachments. d. Each Bidder must be satisfied by personal examination and by such other means as it may prefer, as to the actual conditions and requirements under which the contract will be performed. e. KHS standard Professional Service Agreement (PSA) will be used to contract with the chosen vendor. A blank template is included with this RFP package. Any objections to the terms and conditions stated in that document must be clearly explained and included with the bid package as an additional Attachment F 3. Explanation to Bidders a. If a Bidder desires an explanation of any kind regarding provisions of this RFP, the Bidder must generate a written request for such explanation. The request may be e- mailed to rfp@khs-net.com, faxed to , or addressed to: Kern Health Systems Attention: Purchasing Department 9700 Stockdale Highway Bakersfield, CA b. Requests for explanation must be submitted by 2/14/2014, allowing sufficient time for a reply to reach all Bidders before the submission of their Proposals. The Purchasing Manager or duly authorized personnel will advise all candidates known to have received a copy of the RFP of each question and subsequent explanation. 4. Amendments a. Bidders are advised that KHS reserves the right to amend the requirements of this RFP prior to the date set for opening of bids. Such revisions will be done formally by publishing amendments to all Bidders known to have received a copy of the RFP. This may be done via fax, , or other method as determined by KHS. Amendments will be posted to the KHS website: listed under the specific RFP. If in the judgment of KHS, the change is of such nature that additional time is required for Bidders to prepare their Proposals, KHS will change the date of the Proposal opening and notify all Bidders by and it will be posted to the KHS website.

5 b. Bidders are requested to acknowledge receipt of amendments to an RFP. This may be done by any one of the following means: 1) Sign and return the amendment via or fax. 2) Sign Attachment D, Proposal Signature Verification. 5. Submitting Proposals a. Please submit THREE (3) hard copies of your Proposal and ONE (1) electronic copy. Electronic copy should be submitted via to b. Mailed or third-party delivered Proposals and amendments of Proposals shall be enclosed in sealed envelopes and addressed to KHS Purchasing Department, 9700 Stockdale Highway, Bakersfield, CA Proposals shall be clearly identified by stating, ATTENTION PURCHASING: Core Software System shown on the outside of the envelope. Proposals and/or amendments may be hand delivered, but the foregoing information will nevertheless be required for identification purposes. KHS is not responsible for delinquent delivery issues. c. Faxed proposals and amendments will NOT be considered. d. Alternate Proposals are not authorized and will NOT be considered. e. All Proposals must be received by KHS no later than 2/28/2014. Late Proposals will NOT be considered or accepted. 6. Non-Collusion Affidavit Each Bidder is required to complete the document entitled, Non-Collusion Affidavit on the form provided herein (Attachment E). 7. Bidders Response Information Since KHS is a public entity, all responses may be disclosed through the Public Records Act. KHS may keep submissions and negotiations confidential until the Governing Board approves the final contract and/or a Purchase Order is issued. 8. Award of Contract a. Award will be made, in whole or in part, to the responsive, responsible Bidder whose Proposal is determined by KHS to be most advantageous to KHS, price, delivery, and others factors considered. b. KHS may reject any or all bids, and may waive informalities and minor irregularities in bids received. c. THE CONTRACT IS SUBJECT TO KHS GOVERNING BOARD APPROVAL. 9. Evaluation Process a. The determination and final selection of the successful Bidder will be based upon evaluation by KHS considering all factors and such other criteria (subjective and otherwise) as KHS may, at its sole discretion, deem relevant. In no event will KHS be limited to selecting a Bidder based solely upon total cost submitted. b. Including the Total Price, the following overall factors will be considered: Corporate capabilities Responsiveness to RFP Experience with California Medicaid (Medi-Cal) and core software solutions Value-added services Timeliness of service Trade reference and/or referrals

6 History of compliance with government contracts and laws c. KHS will provide special consideration to vendors located and doing substantial business in Kern County. 10. Company Evaluation Bidders shall provide responses to the series of questions and information requested in Attachment C that will be used to evaluate the Bidder s company. Responses to individual questions/information request should be kept to a single page, except as designated. 11. Late Bids No Proposal or Proposal Amendment received at the office designated in this RFP after the time set for receipt specified in this RFP will be considered or accepted. 12. Cost of Preparation of Bids Costs for developing responses to this proposal are entirely the responsibility of the Bidder. 13. Withdrawal of Bids a. Proposals may be withdrawn by letter or in person by a Bidder or an authorized representative possessing proper identification and written proof of his authority to act on behalf of the Bidder. If withdrawn in person by a Bidder or a representative of the Bidder, the person withdrawing the Proposal will be required to sign a receipt for the Proposal. b. Withdrawal action of any type must be done before the date and time specified for opening of bids in this RFP. 14. Payment a. Invoices for services rendered shall be directed to: Kern Health Systems Accounts Payable 9700 Stockdale Highway Bakersfield, CA b. Payment will be made upon receipt of an appropriate invoice and determination by KHS where products and/or services have been determined by KHS to be satisfactorily provided, and subject to the terms of the contract. Payment terms are Net 30 after receipt of a valid invoice. KHS is unable to take advantage of any prompt-payment discounts. KHS is not responsible for misdirected invoices. 15. Miscellaneous a. The successful Bidder may not assign the contract or any part of its obligations without the prior written consent of KHS, which may be withheld in its sole discretion. b. The successful bidder will enter into a Professional Services Agreement ( PSA ) with KHS. c. Bidder recognizes that the Medi-Cal Managed Care and Healthy Families programs are dynamic programs that are subject to numerous legislative and regulatory changes, which will likely require the successful Bidder to implement related changes to the agreement that may be awarded pursuant to this RFP. 16. Timeline The following timeline is based on KHS requirements and will be strictly adhered to unless modified by amendment

7 February 3, 2014 RFP release February 14, 2014 Bidders Questions Due (1:00PM), Please . February 19, 2014 KHS will responses to all Bidders February Proposals due (2:00PM) March 21, 2014 Proposal evaluations complete, three finalists selected March 31-April 11, 2014 Three finalists and KHS System Review/Question Period April 21- May 30, 2014 Contracting and legal June 12, 2014 Proposed contract presented to KHS Board for approval June 13, 2014 Award Announcement June 13, 2014 Notwithstanding the approval of the contract by the KHS Governing Board, the contract, its terms and conditions, and the commencement of operations thereunder are subject to regulatory approval and modification. B. STATEMENT OF PURPOSE This RFP contains a list of requirements for the development of a current core managed care software system that operationally and technologically aligns with Kern Health System. KHS is soliciting responses from qualified Bidders to address the stated requirements of this RFP. A qualified Bidder, for the purpose of this RFP, is one that can reliably provide the required services to KHS and perform to the satisfaction of KHS and its regulators for the entire term of the agreement. Upon receipt of this RFP, recipients are expected to read and understand the service priorities and requirements that have been defined by KHS. Ample opportunity will be given to ask questions and receive clarification. The final Proposal submitted should include all appropriate goods and services required to satisfy the identified priorities and requirements. KHS will look to the selected vendor for technical compatibility of components and application requirements satisfaction during the entire term of the agreement. KHS management would prefer to have an ongoing relationship with the chosen Bidder. The character and operating principles of the successful Bidder are important to KHS management. The following sections ask questions about the history and purpose of the Bidder s company. Please answer the specific questions. If additional information would be informative to KHS management please add it to the last question in each section. Bidders should number all responses with the section letter and section number. C. BACKGROUND INFORMATION KHS is a public agency formed under Section of the California Welfare and Institutions Code. KHS began full operations on September 1, KHS serves about 140,000, Medi-Cal and Healthy Families participants in Kern County. Medi-Cal is a jointly funded, Federal-State health insurance program for certain low-income people.

8 ATTACHMENT A SCOPE OF SERVICES 1.0 Company Background 1.1 Outcome: Kern Health Systems (KHS) intends to migrate or replace the current DST PowerMHC core system that is currently in production. The goal of the organization is to update its system with a modern platform that aligns with the technologies established within KHS and to improve operational processes in order to increase organizational efficiency. 1.2 Business Model: KHS manages approximately 140,000 lives under its Knox-Keene license for the State of California Medicaid program called Medi-Cal. Kern operates a fee for service model for the majority of its population and contracts with over 500 various entities. KHS has a small population (3,000 members) that it has assigned to Kaiser Permanente in a fully delegated model. The company operates with the following departments: Claims; Utilization Management; Quality Improvement; Disease Management; Health Education; Member Services; Pharmacy; Corporate Services; Marketing; Information Technology; and Executive. Other delegated functions are pharmacy benefits; vision; and mental health. Kern receives approximately 1.2M medical claims from providers annually of which 85% are in EDI format, and 2014 revenue estimates are expected to be $385M. 1.3 Information Technology Environment: The technology group within KHS consists of operational technologist; technical analysts; application development; database development; and data analysts. KHS leverages an enterprise agreement with Microsoft; therefore, uses many Microsoft technologies within the company. The internal workflow solution is a.net MVC architecture over Microsoft SQL databases. The database team uses SSIS and Pentaho for its Extract Load and Transformation (ETL) processes and Business Objects for the data delivery and analytics. BizTalk is the primary tool for HIPAA EDI transformations and the Microsoft SQL platform for data warehousing. 2.0 System Requirements. 2.1 Vendors should respond with a description of the features and functions that their system provides as it relates to each of the following operational functions. Only describe functions or items that will be provided under the RFP response. If there is a third-party tool that can provide the solution or an alternate module that is not part of the RFP please list it as a Third-Party Option as not all items are expected to be part of a single solution Benefit Management Member Management Provider Management Credentialing Contracts

9 2.1.4 Quality Improvement Health Education Site Review Pay for Performance Utilization Management Referrals Authorizations Medical Management Case/Care Management Claims Processing Adjudication Overpayment Disputes Coordination of Benefits Auditing Customer Service Call Center Integration Member Call History Grievance and Appeals Financial Accounts Receivable Premium Billing Accounts Payable Capitation Technology Configuration Management Correspondence / Letters Security / Access Control Workflow Application Programming Interface / Service Oriented Architecture Data Warehouse Reporting Imaging / Document Management

10 3.0 Costs 3.1 License KHS will initially license the software for a five (5) year period, and expects that 200 users will access the core system Vendor needs to outline the license model (perpetual, subscription) that the software leverages and identify all initial and long-term licensure costs associated with the software KHS will require license for a test and production environment to sustain the company. 3.2 Hardware Identify any third-party hardware requirements that will be required to install, configure, or maintain the test and production system. 3.3 Software Identify any third-party software requirements that will be required to install, configure, or maintain the test and production system. 3.4 Professional Services List all professional services costs that KHS should expect to incur associated with the test and production system in the following manner: Installation and Configuration Testing Implementation Post Implementation Miscellaneous 3.5 Training Identify any training requirements and associated costs that KHS will be expected to incur for the core system migration or replacement project List any ongoing training courses, location, and associated costs that the vendor has available post implementation for new employees. 3.6 Support List any support costs that KHS will incur for ongoing support of the proposed solution in years one (1) through five (5) for the test and production system Provide the scope of support that will be available to KHS for ongoing technical and system support for the proposed solution. Include operating hours, time zone, and description of the support provided. 3.7 Maintenance List any maintenance costs that KHS will incur for ongoing support of the proposed solution in years one (1) through five (5) for the test and production system Identify the current or latest systems version.

11 3.7.3 Outline the vendor s current software development lifecycle (SLDC) or application lifecycle management (ALM) for the proposed solution In a summarized format please describe a customer s typical upgrade to a newer version with any associated costs that are billed by the vendor. 4.0 Future Capabilities. 4.1 KHS has several projects over the next twelve to twenty-four months that will involve the core system. Vendor should respond with a brief description of any internal products or Third-Party Option availability and budgetary pricing for the following solutions Provider Portal Member Portal Case/Care Management Solution Customer Relationship Management

12 ATTACHMENT B SCHEDULE OF FEES Proposal Costs (This section is derived from the Scope of Services, Attachment A) A. Define your proposed method of reimbursement for services provided through your organization. Kern Health Systems customarily prefers itemized billing on a project basis (or as major milestones are accomplished for very large projects) with specific deadlines identified in the Proposal. B. Please provide a summary table matrix of costs by line item including: 1. Item description 2. Quantities required (specify units of measure) 3. Not-to-exceed amounts for installation or travel 4. Target date of completion C. List any additional costs that may be incurred in completion of this project and the circumstances that would trigger those costs.

13 ATTACHMENT C COMPANY EVALUATION CRITERIA A. Provide a functional organizational chart of your company. Indicate the name and experience of the Manager or Lead Employee that will be assigned to Kern Health Systems and the functional area to which this position reports. If your company is NOT a full service consulting organization, indicate which services are subcontracted in the functional organizational chart. The following chart is for illustration purposes only: ABC Consulting Company Organizational Chart CEO CFO B. IMPORTANT: Bidder s present financial statements are necessary and must be part of the Proposal submission. If any type of prepayment is required, Bidder must provide company s summary of its present financial status and performance for the past three years C. Organizational information 1. Provide a summary list of the organizational personnel that will actively participate and contribute their skills to this project. Include in this list the individual s name, job title, work location and relevant experience in projects of similar size and complexity. (Responses may be one page per individual.) 2. Provide a summary of the work plan and/or methodology and physical resources (staff and equipment) your company will commit to ensure successful project completion. (Response may be up to four pages.) 3. Summarize your company s overall project services that you are able and willing to provide. 4. Provide three current customer references of organizations currently receiving products or services similar to those proposed. Include in the reference list organization name, location, contact name and telephone number. 5. Summarize your billing procedures. 6. List the members of your organization who are authorized to negotiate Proposals/Contracts. 7. What is your company s Mission Statement?

14 8. How long has your company been in business? 9. Describe the educational background and experience of the key members of the project team your firm would assign to KHS project. 10. Describe your company s experience with health insurance plans. 11. Describe your company s experience with governmental agencies (in particular, California Department of Health Care Services, California Department of Managed Health Care, and the Centers for Medicare and Medicaid Services). 12 Does your company perform audits or consulting services for any Independent Physician Associations (IPAs) or hospitals? 13. Is your firm currently under investigation or being sued by any governmental agency? If so, describe. 14. Has your company been investigated or sued by any governmental agency over the past five years? If so, describe. 15. Has your company been sued over the last five years for services similar to those that are the subject of this RFP? 16. Has your company been the subject of a sanction, audit deficiency, settlement or Corporate Integrity Agreement under the Medicare or Medicaid Programs? 17. What is the form of your organization? (e.g., profit, not-for-profit, private, public) 18. List any shareholders who own five or more percent of the company and their percent share. 19. Describe your organization s policies, procedures and protocols to protect Protected Health Information under HIPAA, HITECH and the California Confidentiality of Medical Information Act. Add any information that would be useful in describing your company.

15 ATTACHMENT D PROPOSAL SIGNATURE VERIFICATION All offers in response to this RFP must be received on or before 2/28/2014 at the office of Kern Health Systems, Attn: Purchasing Dept., 9700 Stockdale Highway, Bakersfield, CA All offers are subject to the attached Instructions and Conditions, general provisions, special provisions, and Attachments. The undersigned agrees, if its offer is accepted (in whole or in part) to provide products, other materials, and services as set forth in the Attachments, it shall do so in accordance with the provisions of this RFP, the controlling contract between the parties, and the master contracts between KHS and the State of California. Offer Name: Address: Phone Number: FAX: Typed or printed name and title of person authorized to sign offer: Signature of Authorized Person: Date of Offer: Grand Total of Attachment B : $ Acknowledgment of Amendments The Offer acknowledges receipt of Amendments to the RFP numbered and dated as follows: Amend # Date Amend # Date Amend # Date

16 ATTACHMENT E NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH PROPOSAL (Mandatory) State of California County of Kern, being first duly sworn, deposes and says that he or she is of the party making the foregoing proposal that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham proposal, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the bidder or any other bidder or to fix any overhead, profit, or cost element of the proposal price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; and, further, that the bidder has not, directly or indirectly, submitted his or her proposal price or any breakdown thereof, or the contents thereof, or divulged information or date relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. (Public Contractas Code, section 7106) Signature Date